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YEAR 4 > Obs and Gynae > Flashcards

Obs and Gynae Flashcards

1
Q

What is the definition of pre-eclampsia?

A

High blood pressure after 20 weeks gestation >140/90
Proteinuria
Signs of other organ failure (renal, liver, neurological etc).

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2
Q

Personal Hx, Chronic HTN, Nulliparity and Maternal age over 40 are some risk factors for Pre-eclampsia: Name 8 more.

A

10 years between pregnancies
Previous HTN in pregnancy
Diabetes
Chronic Kidney Disease
Family hx
Multiple pregnancy
BMI over 35
Autoimmune conditions

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3
Q

Headaches and visual disturbance are two of the symptoms of pre-eclampsia, name 3 more.

A

Hyperreflexia
Peripheral oedema
Epigastric or RUQ pain

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4
Q

Intrauterine growth restriction is a foetal complication of pre-eclampsia, name two more foetal complications.

A

Intrauterine death
Prematuiry

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5
Q

Seizures (eclampsia) is a maternal complication of pre-eclampsia, name 3 more.

A

Death
Haemorrhage: post-partum, intracerebral
HELLP syndrome

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6
Q

When should pregnant women be prescribed prophylactic treatment for pre-eclampsia and what is this?

A

If they have 1 high risk factor or 2 moderate risk factors.
High dose aspirin (75-150mg) every day from week 12 of the pregnancy.

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7
Q

If a pregnant lady presents with a blood pressure of 150/90 what should she be prescribed, when would this be contraindicated and what would be prescribed instead?

A

Labetalol
IF the lady has asthma -> nifedipine

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8
Q

If the lady develops eclampsia what should be prescribed, what needs monitoring after this prescription and what is the antidote incase of overdose?

A

IV magnesium sulphate (4g)
Relfexes, respiratory rate, urine output and oxygen sats.
Calcium gluconate

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9
Q

How long should the treatment for eclampsia continue?

A

For 24 hours after the last seizure or delivery of the baby - dependent on whether the mother continues to seize after the birth.

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10
Q

What should be done about fluids in the management of severe pre-eclampsia?

A

Fluid restriction to avoid fluid overload (dysfunctioning kidneys).

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11
Q

When is same-day delivery an option in the management of severe pre-eclampsia?

A

After 34 weeks gestation.

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12
Q

Other than IV labetalol what can be used to reduce blood pressure during delivery for a women with pre-eclampsia?

A

Epidural

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13
Q

The ampulla is the most common location for an ectopic pregnancy, where is the most dangerous location?

A

Isthmus

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14
Q

Abdominal pain and bleeding are two symptoms of ectopic pregnacies, name 2 more.

A

Shoulder tip pain
Dizziness and/or syncope

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15
Q

Abdominal tenderness is a common finding on examination of a patient with an ectopic pregnancy, what is another finding?

A

Cervical excitation

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16
Q

PID, previous hx of ectopic and endometriosis are some risk factors for ectopic pregnancies, name 3 more.

A

Progesterone only pill
Copper IUD
IVF

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17
Q

What is the medical management of an ectopic pregnancy?

A

Methotrexate

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18
Q

> /= 35mm and pain are two indications for surgical management of an ectopic pregnancy, name 3 more indications.

A

Visible heartbeat
Rupture
Beta HCG over 5000IU/L

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19
Q

When is a salpingotomy the preferred method of surgery over a salpingecotomy?

A

When the patient only has one viable fallopian tube, to preserve fertility.

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20
Q

BMI >30 and previous hx are two risk factors for gestational diabetes, name 3 more.

A

First-degree relative with diabetes
Previous macrosomia (over 4.5kg)
Family origin of high prev (south-asian, afro-caribbean or middle eastern).

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21
Q

When should women with a previous hx of GD recieve OGTT?

A

As soon as possible after booking and then if normal again at 24-28 weeks.

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22
Q

Who should also receive an OGTT at 24-28 weeks?

A

Women with risk factors for GD.

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23
Q

When should women be started on insulin?

A

If they have a fasting glucose of over 7mmol/L on booking or they have trialled diet and exercise (with the addition of metformin) and this is unsuccessful.

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24
Q

Weight loss (over 27kg/m2) is one of the management strategies for women with pre-existing diabetes whilst they are pregnant, what else should be included in the management?

A

Stop diabetic medications other than metformin and begin short-acting insulin.
Folic acid 5mg from before conception to 12 weeks gestation.
Detailed 20 week anomaly scan with emphasis on cardiac function.
Close monitoring and potential treatment of retinopathy (can worsen during pregnancy).
Tight glycaemic control.

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25
Q

Nulliparity, early menarche, late menopause, unopposed oestrogen are 4 risk factors for endometrial cancer, name 5 more.

A

Obesity
Diabetes
PCOS
Tamoxifen
Hereditary non-polyposis colorectal carcinoma

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26
Q

The COCP is protective against endometrial cancer, name 2 more protective factors.

A

Multiparity
Smoking

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27
Q

What is the indication for referral for 2WW with endometrial cancer, and what investigations are done?

A

55 and over who present with postmenopausal bleeding.
TVUS
Hysteroscopy with endometrial biopsy.

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28
Q

What surgery is suitable for endometrial cancer?

A

Total abdominal hysterectomy with bilateral salpingo-oophorectomy.

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29
Q

What are the three elements of the Rotterdam criteria?

A

Oligoovulation or anovulation (irregular or absent periods)
Hyperandrogenism (hirsuitism + acne)
Polycystic ovaries on USS

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30
Q

Oligomenorrhoea, infertility, obesity, hirsuitism, acne and hair loss (male pattern) are all common features of PCOS, name 8 more features and/or complications that may be present in a patient with PCOS.

A

Cardiovascular disease
Ancanthosis nigricans
Insulin resistance and diabetes
Hypercholesterolaemia
Endometrial hyperplasia and cancer
Obstructive sleep apnoea
Depression and anxiety
Sexual problems

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31
Q

What are some differential diagnoses for hirsuitism?

A

Medications
Ovarian or adrenal tumours
Cushing’s syndrome
Congenital adrenal hyperplasia

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32
Q

Testosterone, LH and FSH are measured in patients with suspected PCOS, name 3 more blood tests that should be carried out.

A

Thyroid function tests
Sex hormone-binding globulin
Prolactin (may be milding elevated in PCOS)

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33
Q

In PCOS which is higher LH or FSH?

A

LH

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34
Q

What ovarian volume (even with the absence of cysts) can indicate polycystic ovarian syndrome?

A

10cm3

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35
Q

What is the characteristic appearance of PCOS on USS?

A

String of pearls

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36
Q

Weight loss is one of the management strategies for PCOS, name 5 more.

A

Calorie-controlled diet
Exercise
Smoking cessation
Antihypertensive medications (where required)
Statins (where indicated QRISK score over 10%)

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37
Q

Hirsuitism is one of the associated features that needs to be assessed and managed in PCOS, name 5 more.

A

Acne
Obstructive Sleep apnoea
Depression and anxiety
Infertility
Endometrial hyperplasia and cancer

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38
Q

What medication can be used for women that are above 30kg/m2? (pcos)

A

Orlistat (lipase inhibitor)

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39
Q

How can the risk of endometrial cancer be reduced in women with PCOS?

A

Mirena coil (continuous endometrial protection).
Inducing a withdrawal bleed - either with cyclical progestogens or COCP.

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40
Q

Weight loss is a management option for the infertility associated with PCOS, name 3 more.

A

Clomifene
Laparoscopic ovarian drilling (diathermy or laser therapy)
IVF

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41
Q

What is the firstline treatment for hirsuitism?

A

Topical eflornithine

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42
Q

Itching is one of the main sx of Obstetric cholestasis, name 4 more.

A

Fatigue
Dark urine
Pale, greasy stools
Jaundice

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43
Q

Previous hx is a risk factor for obstetric cholestatsis, name 4 more.

A

Fhx
Hx of liver problems, hepatitis, gallbladder issues.
Pregnancy above 35
Multiple pregnancy

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44
Q

What are the differential diagnoses that should be excluded for obstetric cholestasis?

A

Acute fatty liver
Gallstones
Autoimmune hepatitis
Viral hepatitis

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45
Q

What are the characteristic blood results for obstetric cholestasis?

A

Abnormal LFTs - ALT, AST and GGT
Raised bile acids

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46
Q

Which LFT is usually raised in pregnancy? Why?

A

ALP - The placenta produces ALP.

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47
Q

How can the itching experienced in obstetric cholestasis be managed? What can be prescribed for sleep?

A

Emollients
Antihistamine (chlorphenamine)

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48
Q

When should delivery be induced in obstetric cholestasis and why?

A

37-38 weeks
Risk of stillbirth

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49
Q

Which SSRIs are safe for breastfeeding women?

A

Sertraline
Paroxetine

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50
Q

Previous caesarean sections, previous placenta praevia and older maternal age are 3 risk factors for placenta praevia, name 3 more.

A

Maternal smoking
IVF
Uterine structural abnormalities.

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51
Q

Judy had placenta praevia noted when she had her 20 week anomly scan, when should she have repeat transvaginal USS?

A

32 week
36 weeks (if present at 32 to guide delivery options)

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52
Q

What are the extra management and precautions that should be put in place for women with placenta praevia?

A

Corticosteroids between (34-36) - risk of prematurity
Planned delivery at 36-37 weeks (planned caesarean is needed)

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53
Q

When may an emergency caesarean be indicated for placenta praevia?

A

Antenatal bleeding
Premature labour

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54
Q

If an antepartum haemorrhage does occur what mx options may be required?

A

Emergency c-section
Blood transfusion
Intrauterine balloon tamponade
Uterine artery embolisation/occlusion
Emergency hysterectomy

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55
Q

Stillbirth is one of the foetal complications of placenta praevia, name 2 more foetal complications.

A

Low birth weight
Preterm birth

56
Q

Antepartum haemorrhage is the main maternal complication of placenta praevia, name 3 more.

A

Emergency c-section
Emergency hysterectomy
Maternal anaemia

57
Q

What is characteristic about the shock seen in placenta praevia?

A

Proportional to the amount of visible loss.

58
Q

What are the 4 types of fibroid?

A

Intramural
Subserosal
Pedunculated
Submucosal

59
Q

Heavy menstrual bleeding and prolonged menstruation are two presenting features of fibroids, name 5 more.

A

Abdominal pain (worse during menstruation)
Bloating
Urinary or bowel sx (pressure)
Deep dyspareunia
Reduced fertility

60
Q

What are the firstline mx options for fibroids <3cm?

A
  1. mirena coil
  2. sx mx with NSAIDs
  3. COCP
  4. Cyclical oral progestogens
61
Q

What are the surgical options for small fibroids with HMB?

A

Endometrial ablation
Resection of submucosal fibroids during hysteroscopy
Hysterectomy

62
Q

What are the mx options for fibroids >3cm?

A

Referral to gynaecology
1. Sx mx with NSAIDs
2. mirena coil - dependent on the shape and distortion of uterus.
3. COCP
4. Cyclical oral progestogens

63
Q

What are the surgical options for larger fibroids?

A

Uterine artery embolisation
Myomectomy (preserve fertility)
Hysterectomy

64
Q

What medication can be used to reduce the size of fibroids prior to surgery? Give 2 examples.

A

GnRH agonists
Goserelin
Leuprorelin

65
Q

HMB and reduced fertility are potential complications of fibroids, name 6 more.

A

Pregnancy complications - miscarriages, premature delivery and obstructive delivery
Constipation
Urinary outflow obstruction and UTIs
Red degeneration
Torsion
Malignant change into leiomyosarcoma (<1%)

66
Q

How would a patient with red degeneration of a fibroid present?

A

Low grade fever, severe abdo pain, tachycardia and often vomiting. Second/third trimester of pregnancy.

67
Q

What are the cut offs to determine whether a woman should recieve iron supplementation during the different stages of pregnancy?

A

First trimester = 110
Second/third trimester = 105
Post-partum = 100

68
Q

At what stage does a perineal repair need to be done in theatre?

A

Once it has reached stage 3 (involvement of the anal sphincter).

69
Q

How long do you need to wait to start hormonal contraception after taking Ulipristal Acetate?

A

5 days

70
Q

When should anti-D be given for ectopic pregnancies?

A

Surgical management or rupture.

71
Q

How long after medical management of an ectopic should a pregnancy test be performed?

A

3 weeks.

72
Q

Which contraceptive options are that are unaffected by enzyme inducing drugs (e.g. carbamazepine)?

A

IUD
Depo
Mirena

73
Q

What is the most appropriate investigation for a women presenting with a suspected rupture of membranes?

A

Sterile speculum examination
Looking for amniotic fluid pooling.

74
Q

Antepartum haemorrhage, Ectopic pregnancy, Abdominal trauma and External cephalic version are 4 examples of potentially sensitising events in pregnancy, name 6 more.

A
  • Evacuation of retained products of conception and molar pregnancy
  • Vaginal bleeding < 12 weeks, only if painful, heavy or persistent
  • Vaginal bleeding > 12 weeks
  • Chorionic villus sampling and amniocentesis
  • Intra-uterine death
  • Post-delivery (if baby is RhD-positive)
75
Q

What can cause rasied AFP in pregnancy?

A

Omphalocoele
Neural tube defects
Multiple pregnancy

76
Q

Within what timeframe should a CAT 1 caesarean section be performed?

A

30 mins

77
Q

Within what timeframe should a CAT 2 caesarean section be performed?

A

75 mins

78
Q

When should women who have been treated for CIN be offered a repeat smear?

A

6 months

79
Q

After 24 weeks how much should the fundal height increase by each week?

A

1cm

80
Q

Suspected uterine rupture is one of the indications for a CAT 1 c-section, name 4 more.

A

Persistent bradycardia
Cord Prolapse
Foetal hypoxia
Major placental abruption

81
Q

When is the risk of downs syndrome significant?

A

Less than 1/150

82
Q

How does androgen insensitivity normally present?

A

Primary amenorrhoea, little or no axillary and pubic hair, elevated testosterone.

83
Q

How would fibroid degeneration present?

A

Abdominal pain.
Low-grade fever.
Vomiting

84
Q

What is the main risk with oestrogen-only HRT?

A

Endometrial cancer

85
Q

What is the main risk with combined HRT?

A

Breast cancer

86
Q

If you miss one pill on the COCP what is the advice?

A

Take the pill immediately (even if it means taking two in one day) and then carry on as usual.

87
Q

What are the sx to safety net a mother having monochorionic twins?

A

Twin to Twin transfusion.
Sudden increase in the size of her abdomen and/or breathlessness.

88
Q

Previous caesarean section with a vertical scar is an absolute contraindication for a vaginal delivery following previous caesarean section, name 2 more.

A

previous episodes of uterine rupture
patients with other contraindications to vaginal birth (e.g. placenta praevia).

89
Q

What forms of contraception are contraindicated in transgender males (assigned emale at birth) who are undergoing testosterone therapy?

A

Contraceptives containing oestrogen.

90
Q

On USS what does a ‘snow-storm’ sign indicate during pregnancy?

A

Complete hydatidiform mole.

91
Q

How long after insertion can the IUS be relied upon as contraception?

A

7 days

92
Q

What is the most appropriate antibiotic to prescribe for PPROM?

A

10 days oral erythromycin

93
Q

Which scale is most appropriate for the assessment of post-partum depression?

A

Edinburgh scale

94
Q

What is the definition of premature ovarian insufficiency?

A

Onset of menopausal sx and elevated gonadotrophin levels before the age of 40 years.

95
Q

Idiopathic and bilateral oopherectomy are two causes of POI, name 5 more.

A

Radiotherapy
Chemotherapy
Infection (mumps)
Autoimmune disorders
Resistant ovary syndrome (FSH receptor abnormalities)

96
Q

What is the mx of POI?

A

HRT or COCP until age of average menopause.

97
Q

Maternal trauma and multiparity are two known associations with placental abruption, name 3 more.

A

Cocaine use
Proteinuric hypertension
Increasing maternal age

98
Q

Pain, bleeding and tender uterus are 3 features of placental abruption, name 4 more.

A

Foetal HR distress
Shock out of keeping with visible blood loss
Normal lie and presentation

99
Q

What are the two types of Placental Abruption?

A

Concealed (closed os)
Revealed (open os)

100
Q

In a case of placental abruption less than 36 weeks gestation and the foetus is alive and there are no signs of distress on the CTG what is the mx?

A

Admit
Observe closely
Steroids
No tocolysis

101
Q

In a case of placental abruption less than 36 weeks gestation and the foetus is alive but there are signs of distress on the CTG what is the mx?

A

Immediate caesarean section

102
Q

In a case of placental abruption over 36 weeks gestation and the foetus is alive but there are signs of distress on the CTG what is the mx?

A

Immediate caesarean section

103
Q

In a case of placental abruption over 36 weeks gestation and the foetus is alive and there are no signs of distress on the CTG what is the mx?

A

Deliver vaginally

104
Q

DIC and shock are two maternal complications of placental abruption, name two more.

A

Post-partum haemorrhage
Renal failure

105
Q

Multifoetal pregnancy is one of the risk factors for obstetric cholestasis?

A

Previous history of liver problems
Advanced maternal age
South asian ethnicity

106
Q

What are the three elements of the Risk Malignancy index for ovarian cancer?

A

Menopausal status
CA-125
US findings

107
Q

What is a ‘boggy uterus’ suggestive of?

A

Adenomyosis

108
Q

At what gestation should you be worried if you cannot feel any foetal movements?

A

> /=24

109
Q

What is the stepladder of treatment for endometriosis?

A

Mefenamic acid or ibuprofen/paracetamol
COCP/POP
GnRH agonsits

110
Q

At what stage should an USS be doen to assess the cause of prolonged lochia?

A

6 weeks.

111
Q

What is the firstline treatment option for thrush during pregnancy?

A

Clotrimazole pessary

112
Q

Why is urinalysis the firstline investigation for women presenting with incontinence?

A

Need to rule out diabetes and urinary tract infection.

113
Q

What is the antibiotic used to treat gonorrhoea?

A

Ceftriaxone IM

114
Q

What is the treatment for Trichomonas vaginalis?

A

Metronidazole Oral

115
Q

What is the most common complication with the induction of labour?

A

Uterine hyperstimulation syndrome

116
Q

Which screening are pregnant women offered ideally before 10 weeks gestation?

A

HIV
Syphilis
Hep B

117
Q

A 33-year-old primigravida woman of 32 weeks gestation presents to the Emergency Department with premature rupture of membranes. There have been no complications of the pregnancy so far and the woman is normally fit and well. How is she best managed?

A

Admit for at least 48 hours and administer both prophylactic antibiotics and corticosteroids.

118
Q

When can the implant be safely used after birth?

A

Anytime
If exclusively breastfeeding it is not needed.

119
Q

What are the stages of the first stage of labour?

A

1st stage of labour
latent phase = 0-3 cm dilation
active phase = 3-10 cm dilation

120
Q

What is the normal number of contractions in 20 minutes?

A

4 or less

121
Q

What are the antenatal measures for HIV in pregnancy?

A

Anti-retorvirals at 24 weeks (dependent on viral load)

122
Q

What are the perinatal measures for HIV in pregnancy?

A

IV infusion of anti-retrovirals
<50 copies vaginal delivery
>400 definite c-section

123
Q

What are the postnatal measures for HIV in pregnancy?

A

Infant anti-retrovirals
- very low risk (10 weeks, 36 viral load is undetectable): 2 weeks.
- high risk: 3 diff anti-retrovirals for 6 weeks.

124
Q

What are some of the causes of placental insufficiency?

A

Diabetes.
Post-dates
Preeclampsia
Medical conditions that increase the mother’s chances of blood clots (antiphospholipid).
Smoking.
Taking cocaine or other drugs.
Anaemia.

125
Q

What do you need to do before and after ECV?

A

Uterine relaxant - terbutaline
Kleihauer test - then Anti-D prophylaxis

126
Q

What tests are done to test the amniotic fluid in a suspected rupture of membranes?

A

Amnisure - PAMG-1
Insulin-like growth factorbinding protein 1 (IGFBP-1)

127
Q

What are the pros of vaginal delivery after c-section?

A

75% if one previous c-section
Risks of vte avoided
Faster recovery
Reduce risks of injury to baby (1 in 100)
Breathing difficulties for the baby

128
Q

What are the cons of vaginal delivery after c-section?

A

1 in 200 scars rupture
25% emergency c-section
Increased risk of blood transfusion

129
Q

When do you get treatment for VTE risk in pregnancy?

A

3 risk factors = from 26 weeks till 12 weeks
4 risk factors or previous VTE = immediate till 12 weeks

130
Q

What are two theories behind the development of endometriosis?

A

Retrograde menstruation
Metaplasia

131
Q

What are two theories behind the development of endometriosis?

A

Retrograde menstruation
Metaplasia

132
Q

How long should bladder retraining be tried for in women with urge incontinence?

A

6 weeks

133
Q

How long should pelvic floor exercises be tried for in women with stress incontinence?

A

3 months

134
Q

What is the difference between hypertrichosis and hirsuitism? Give 3 examples of conditions where hirsuitism may be present.

A

Hypertrichosis is increased hair growth. Hirsuitism is when there is increased hair growth on a woman that is in a male pattern.
PCOS
Congenital adrenal hyperplasia
Cushings Syndrome

135
Q

What are the potential risks of SSRI use in the third trimester of pregnancy?

A

Pulmonary hypertension in the newborn.

YEAR 4 (11 decks)

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